Preoperative ocular surface optimization and the role of lacrimal occlusion in dry eye management before cataract and refractive surgery: a critical perspective

Introduction Dry eye disease (DED) impacts all phases of cataract and refractive surgery, from preoperative planning to postoperative recovery. Accurate diagnosis and effective management are critical to achieving optimal visual outcomes and high levels of patient satisfaction. Despite its frequency, DED is often underdiagnosed or inadequately managed prior to surgery.Areas covered This narrative review discusses the rationale, methods, and clinical impact of ocular surface optimization, and presents evidence-based strategies for preoperative ocular surface optimization. PubMed was searched from inception through September 2025, and studies were selected based on relevance and contribution to the scope of the review.Expert opinion As an ophthalmic community it would behoove us to consistently manage DED prior to cataract and refractive surgery. A structured diagnostic and treatment approach that prioritizes ocular surface health should be integrated into standard preoperative protocols. It is important to clearly educate patients on the value of proactive DED management to improve compliance and temper expectations regarding surgical outcomes. Surgeons should be open to newer innovations and algorithms to meet patient needs.